Her C, Kizelshteyn G, Walker V, Hayes D, Lees D E
Department of Anesthesiology, New York Medical College, Westchester County Medical Center, Valhalla 10595.
J Cardiothorac Anesth. 1990 Oct;4(5):552-7. doi: 10.1016/0888-6296(90)90403-3.
The hypothesis that combined epidural and light general anesthesia for infrarenal abdominal aortic surgery is associated with a more stable intraoperative course and less postoperative morbidity than general anesthesia alone was tested. The authors compared intraoperative hemodynamic variables and postoperative morbidity between a group with combined epidural and general anesthesia (n = 30) and a group with general anesthesia (n = 19). Patients who had combined epidural and general anesthesia were given epidural bupivacaine intraoperatively and epidural morphine postoperatively. After cross-clamping of the aorta, cardiac index and pulmonary capillary wedge pressure did not change in the group with combined epidural and general anesthesia, whereas cardiac index decreased (mean change, 0.30 L/min/m2; P = 0.0006) and pulmonary capillary wedge pressure increased (mean change, 1 mm Hg; P = 0.007) in the group with general anesthesia. After unclamping, cardiac index increased in both groups (mean change, 0.26 L/min/m2, P = 0.002, and 0.30 L/min/m2, P = 0.001, respectively). Postoperatively, the necessity for ventilatory support and the incidence of respiratory failure were lower in the combined epidural and general anesthesia group than in the general anesthesia group (P = 0.0002 and P = 0.018, respectively). In addition, vasodilator therapy was required less frequently in the group with combined epidural and general anesthesia (P = 0.002). Duration of intensive care unit stay was shorter in the combined epidural and general anesthesia group (2.7 days v 3.8 days, P = 0.003). These data indicate that for infrarenal abdominal aortic surgery, combined epidural and general anesthesia is associated with more stable intraoperative hemodynamics and significantly less postoperative morbidity than general anesthesia alone.
本研究对硬膜外麻醉联合浅全身麻醉用于肾下腹主动脉手术可使术中过程更平稳、术后并发症更少这一假说进行了验证。作者比较了硬膜外麻醉联合全身麻醉组（n = 30）和全身麻醉组（n = 19）的术中血流动力学变量及术后并发症情况。接受硬膜外麻醉联合全身麻醉的患者术中给予硬膜外布比卡因，术后给予硬膜外吗啡。主动脉交叉阻断后，硬膜外麻醉联合全身麻醉组的心脏指数和肺毛细血管楔压未发生变化，而全身麻醉组的心脏指数下降（平均变化0.30 L/min/m²；P = 0.0006），肺毛细血管楔压升高（平均变化1 mmHg；P = 0.007）。阻断解除后，两组的心脏指数均升高（平均变化分别为0.26 L/min/m²，P = 0.002和0.30 L/min/m²，P = 0.001）。术后，硬膜外麻醉联合全身麻醉组的通气支持需求及呼吸衰竭发生率低于全身麻醉组（分别为P = 0.0002和P = 0.018）。此外，硬膜外麻醉联合全身麻醉组较少需要血管扩张剂治疗（P = 0.002）。硬膜外麻醉联合全身麻醉组的重症监护病房住院时间较短（2.7天对3.8天，P = 0.003）。这些数据表明，对于肾下腹主动脉手术，硬膜外麻醉联合全身麻醉与单独全身麻醉相比，术中血流动力学更稳定，术后并发症显著更少。
